CA2712849A1 - Claims analytics engine - Google Patents

Claims analytics engine Download PDF

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Publication number
CA2712849A1
CA2712849A1 CA2712849A CA2712849A CA2712849A1 CA 2712849 A1 CA2712849 A1 CA 2712849A1 CA 2712849 A CA2712849 A CA 2712849A CA 2712849 A CA2712849 A CA 2712849A CA 2712849 A1 CA2712849 A1 CA 2712849A1
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CA
Canada
Prior art keywords
computer
information
data
models
attributes
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
CA2712849A
Other languages
English (en)
French (fr)
Inventor
Rayid Ghani
Leana R. Wallace
Michael S. Irish
Ajay K. Easo
Mohit Kumar
Zhu-song MEI
Dmitriy Feferman
Nicholas F. Howell
Lindsey J. Lizardi
Laura J. Jantzen
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Accenture Global Services Ltd
Original Assignee
Accenture Global Services GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Accenture Global Services GmbH filed Critical Accenture Global Services GmbH
Publication of CA2712849A1 publication Critical patent/CA2712849A1/en
Abandoned legal-status Critical Current

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Classifications

    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08—Insurance
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06N—COMPUTING ARRANGEMENTS BASED ON SPECIFIC COMPUTATIONAL MODELS
    • G06N20/00—Machine learning
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q10/00—Administration; Management
    • G06Q10/10—Office automation; Time management

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  • Engineering & Computer Science (AREA)
  • Business, Economics & Management (AREA)
  • Theoretical Computer Science (AREA)
  • Strategic Management (AREA)
  • Physics & Mathematics (AREA)
  • General Physics & Mathematics (AREA)
  • Finance (AREA)
  • Accounting & Taxation (AREA)
  • General Business, Economics & Management (AREA)
  • Marketing (AREA)
  • Economics (AREA)
  • Entrepreneurship & Innovation (AREA)
  • Data Mining & Analysis (AREA)
  • Human Resources & Organizations (AREA)
  • Software Systems (AREA)
  • Technology Law (AREA)
  • Development Economics (AREA)
  • Quality & Reliability (AREA)
  • Evolutionary Computation (AREA)
  • Operations Research (AREA)
  • Mathematical Physics (AREA)
  • Tourism & Hospitality (AREA)
  • Medical Informatics (AREA)
  • Computer Vision & Pattern Recognition (AREA)
  • Artificial Intelligence (AREA)
  • Computing Systems (AREA)
  • General Engineering & Computer Science (AREA)
  • Information Retrieval, Db Structures And Fs Structures Therefor (AREA)
  • Medical Treatment And Welfare Office Work (AREA)
  • Financial Or Insurance-Related Operations Such As Payment And Settlement (AREA)
CA2712849A 2009-08-25 2010-08-10 Claims analytics engine Abandoned CA2712849A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US12/547,110 US8762180B2 (en) 2009-08-25 2009-08-25 Claims analytics engine
US12/547,110 2009-08-25

Publications (1)

Publication Number Publication Date
CA2712849A1 true CA2712849A1 (en) 2011-02-25

Family

ID=42827395

Family Applications (1)

Application Number Title Priority Date Filing Date
CA2712849A Abandoned CA2712849A1 (en) 2009-08-25 2010-08-10 Claims analytics engine

Country Status (7)

Country Link
US (2) US8762180B2 (zh)
EP (1) EP2290608A1 (zh)
JP (1) JP5586373B2 (zh)
CN (1) CN101996385A (zh)
AU (1) AU2010212343B2 (zh)
CA (1) CA2712849A1 (zh)
MX (1) MX2010009152A (zh)

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US20220138863A1 (en) * 2010-10-11 2022-05-05 Pionetechs, Inc. Method for detecting and preventing fraudulent healthcare claims

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US11244401B2 (en) 2015-10-30 2022-02-08 Hartford Fire Insurance Company Outlier system for grouping of characteristics
US10942929B2 (en) 2015-10-30 2021-03-09 Hartford Fire Insurance Company Universal repository for holding repeatedly accessible information
US10628456B2 (en) 2015-10-30 2020-04-21 Hartford Fire Insurance Company Universal analytical data mart and data structure for same
JP6593231B2 (ja) * 2016-03-14 2019-10-23 富士通株式会社 レセプト電算ファイル作成プログラム、レセプト電算ファイル作成装置及びレセプト電算ファイル作成方法
CN106022892A (zh) * 2016-05-30 2016-10-12 深圳市华傲数据技术有限公司 信用评分模型的更新方法及系统
CN106022912A (zh) * 2016-05-30 2016-10-12 深圳市华傲数据技术有限公司 评价模型的更新方法及系统
CN107871283A (zh) * 2016-09-26 2018-04-03 平安科技（深圳）有限公司 保险理赔的处理方法及装置
CN108230158B (zh) * 2016-12-15 2021-12-03 平安科技（深圳）有限公司 一种理赔测试方法和装置
US11783422B1 (en) * 2017-09-27 2023-10-10 State Farm Mutual Automobile Insurance Company Implementing machine learning for life and health insurance claims handling
US20190095999A1 (en) * 2017-09-28 2019-03-28 Accenture Global Solutions Limited Cognitive agent assistant
KR101974521B1 (ko) * 2017-11-29 2019-05-07 (주)위세아이텍 인공지능 기반의 보험금 부당청구 탐지 장치 및 방법
US10769570B2 (en) * 2017-12-27 2020-09-08 Accenture Global Solutions Limited Artificial intelligence based risk and knowledge management
US11586955B2 (en) * 2018-02-02 2023-02-21 Accenture Global Solutions Limited Ontology and rule based adjudication
US20190279306A1 (en) * 2018-03-09 2019-09-12 Cognizant Technology Solutions India Pvt. Ltd. System and method for auditing insurance claims
JP7198001B2 (ja) * 2018-06-06 2022-12-28 株式会社日立製作所 判定装置、判定方法
US11538112B1 (en) * 2018-06-15 2022-12-27 DocVocate, Inc. Machine learning systems and methods for processing data for healthcare applications
US11270156B2 (en) 2018-06-28 2022-03-08 Optum Services (Ireland) Limited Machine learning for dynamically updating a user interface
US11636455B2 (en) * 2018-07-12 2023-04-25 Inbox Health Corp. Intelligent patient billing communication platform for health services
CN110858214B (zh) * 2018-08-22 2022-07-05 北京国双科技有限公司 推荐模型训练、及进一步审计程序推荐方法、装置及设备
US20200111054A1 (en) * 2018-10-03 2020-04-09 International Business Machines Corporation Automated claims auditing
CN109829150B (zh) * 2018-11-27 2023-11-14 创新先进技术有限公司 保险理赔文本处理方法及装置
CN109636632A (zh) * 2018-12-13 2019-04-16 平安医疗健康管理股份有限公司 基于机器学习的保险理赔方法、装置、设备及存储介质
JP6743116B2 (ja) * 2018-12-25 2020-08-19 みずほ情報総研株式会社 審査支援システム、審査支援方法及び審査支援プログラム
US10977738B2 (en) * 2018-12-27 2021-04-13 Futurity Group, Inc. Systems, methods, and platforms for automated quality management and identification of errors, omissions and/or deviations in coordinating services and/or payments responsive to requests for coverage under a policy
CN109919780A (zh) * 2019-01-23 2019-06-21 平安科技（深圳）有限公司 基于图计算技术的理赔反欺诈方法、装置、设备及存储介质
JP2020129295A (ja) * 2019-02-08 2020-08-27 富士通株式会社 情報処理プログラム、情報処理装置、及び情報処理方法
US11568397B2 (en) 2019-04-24 2023-01-31 Cerner Innovation, Inc. Providing a financial/clinical data interchange
EP3979254A4 (en) * 2019-05-30 2022-07-27 FUJIFILM Toyama Chemical Co., Ltd. DEVICE, METHOD AND PROGRAM TO ASSIST IN REGISTRATION OF MEDICAL INFORMATION
US11315196B1 (en) * 2019-12-03 2022-04-26 Data-Core Systems, Inc. Synthesized invalid insurance claims for training an artificial intelligence / machine learning model
US11461361B2 (en) 2019-12-31 2022-10-04 Cerner Innovation, Inc. Rapid hyperledger onboarding platform
US11449359B2 (en) * 2020-06-12 2022-09-20 Optum Services (Ireland) Limited Prioritized data object processing under processing time constraints
US20210406246A1 (en) * 2020-06-24 2021-12-30 David Mueller Management of diverse data analytics frameworks in computing systems
US11663552B2 (en) * 2020-12-15 2023-05-30 International Business Machines Corporation Dynamically customizing a workflow separate from domain logic
US20230013443A1 (en) * 2021-07-19 2023-01-19 Chevron U.S.A. Inc. Systems and processes for reconciling field costs
US20230063220A1 (en) * 2021-08-30 2023-03-02 EnableComp, LLC Systems and Methods for Predicting Missing Data Values
CN117541171A (zh) * 2023-10-23 2024-02-09 河北智汇邢网络科技有限公司 一种基于区块链的信息处理方法及系统

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Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20220138863A1 (en) * 2010-10-11 2022-05-05 Pionetechs, Inc. Method for detecting and preventing fraudulent healthcare claims
US11823280B2 (en) * 2010-10-11 2023-11-21 Pionetechs, Inc. Method for detecting and preventing fraudulent healthcare claims
US20210117989A1 (en) * 2017-05-05 2021-04-22 Ping An Technology (Shenzhen) Co., Ltd. Method and device of analysis based on model, and computer readable storage medium
US11507963B2 (en) * 2017-05-05 2022-11-22 Ping An Technology (Shenzhen) Co., Ltd. Method and device of analysis based on model, and computer readable storage medium

Also Published As

Publication number Publication date
US20110054925A1 (en) 2011-03-03
CN101996385A (zh) 2011-03-30
US8762180B2 (en) 2014-06-24
MX2010009152A (es) 2011-03-11
EP2290608A1 (en) 2011-03-02
JP5586373B2 (ja) 2014-09-10
US20140249865A1 (en) 2014-09-04
AU2010212343A1 (en) 2011-03-17
AU2010212343B2 (en) 2012-04-12
JP2011048822A (ja) 2011-03-10

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Legal Events

Date Code Title Description
EEER Examination request
FZDE Discontinued

Effective date: 20200831